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Individual
MARK S MYERSON
Active
Individual
MARK S MYERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
D0028380
MD
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
D0028380
MD
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
D0028380
MD
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
D0028380
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
431901000
—
MD
01
—
F730 / 0001
BLUECHOICE
MD
01
—
KBM7 / 350529-09
BC / BS OF MD
MD
Enumeration date
06/13/2006
Last updated
01/25/2010
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